Key result
Prosthesis patient mismatch post-TAVI is linked to blunted LVEF and LV GLS improvement versus no mismatch.
Why the study?
Some patients develop prosthesis patient mismatch (PPM) after TAVI, and identifying which patients are at risk for clinical deterioration remains challenging.
Does prosthesis patient mismatch after TAVI impair left ventricular reverse remodeling in patients with severe aortic stenosis?
Cohort (n=313)
Does prosthesis patient mismatch after TAVI impair left ventricular reverse remodeling in patients with severe aortic stenosis?
Absolute Event Rate: 1.9% vs 8.2%
p-value: p=0.045
Prosthesis-patient mismatch after TAVI is associated with less left ventricular reverse remodeling and lack of functional improvement.
Background Transaortic valve implant (TAVI) is the treatment of choice for severe aortic stenosis (AS). Some patients develop prosthesis patient mismatch (PPM) after TAVI. It is challenging to determine which patients are at risk for clinical deterioration. Methods We retrospectively measured echocardiographic parameters of left ventricular (LV) morphology and function, prosthetic aortic valve effective orifice area (iEOA) and hemodynamics in 313 patients before and 1 year after TAVI. Our objective was to compare the change in echocardiographic parameters associated with left ventricular reverse modeling in subjects with and without PPM. Our secondary objective was to evaluate echo parameters associated with PPM and the relationship to patient functional status and survival post‐TAVI. Results We found that 82 (26.2%) of subjects had moderate and 37 (11.8%) had severe PPM post‐TAVI. There was less relative improvement in LVEF with PPM (1.9 ± 21.3% vs. 8.2 + 30.1%, p = .045). LV GLS also exhibited less relative improvement in those with PPM (13.4 + 34.1% vs. 30.9 + 73.3%, p = .012). NYHA functional class improved in 84.3% of subjects by one grade or more. Echocardiographic markers of PPM were worse in those without improvement in NYHA class (mean AT/ET was .29 vs. .27, p = .05; DVI was .46 vs. .51, p = .021; and iEOA was .8 cm/m 2 vs. .9 cm/m 2 , p = .025). There was no association with PPM and survival. Conclusions There was no improvement in LVEF and less improvement in LV GLS in those with PPM post‐TAVI. Echocardiographic markers of PPM were present in those with lack of improvement in NYHA functional class.
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Peters et al. (2024) conducted a cohort in Severe aortic stenosis (n=313). Prosthesis patient mismatch (PPM) vs. No prosthesis patient mismatch was evaluated on Relative improvement in LVEF (p=0.045). Patients with prosthesis patient mismatch post-TAVI had significantly less relative improvement in LVEF (1.9% vs 8.2%, p=0.045) and LV GLS (13.4% vs 30.9%, p=0.012) compared to those without mismatch.
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